| Background:High prevalence of gastric cancer,a serious threat to human health,resulting in great burden on social economy,new cases and deaths each year in the forefront.Some patients even if the disease early clinical manifestations but also failed to pay attention to,some patients because early asymptomatic,middle-late stage didn’t appear until the disease,cause the majority of patients in hospital when the disease has progress to middle-late.The overall survival rate was low and the quality of life was not improved after treatment.The prognosis depends on the TNM staging system of gastric cancer,and the determination of TNM staging depends on surgical,pathological and imaging examinations.Some patients cannot tolerate surgery,and the diagnosis and treatment methods are complex and expensive.Moreover,studies have shown that even patients in the same TNM stage have different prognosis.Therefore,it is necessary to find other low-cost,fast and convenient indicators that can predict the prognosis of gastric cancer,improve the accuracy of prediction,and provide clinical basis for the development of individualized treatment for patients.In Recent years,peripheral blood coagulation and nutritional indicators in the prognosis of gastric cancer has been paid more and more attention.Objective:The purpose of this study was to investigate the preoperative platelet distribution width and prealbumin prognostic analysis in patients with Ⅲ stage gastric cancer and their relationship with clinicopathological features.Methods:The clinicopathological data of patients who underwent radical gastrectomy for gastric cancer in The Department of Gastrointestinal Surgery of Shiyan People’s Hospital from January 2013 to January 2017 were retrospectively analyzed.Those who had other malignant tumor history,preoperative anti-coagulation and anti-platelet therapy,and died of other diseases,incomplete clinicopathological data and incomplete followed up data were excluded.The clinicopathological data of 80 patients with III stage gastric cancer were completely collected in this study.There were56 males and 24 females.There were 30 patients aged less than 50 years and 50 patients aged greater than or equal to 50 years.Tumors were located in the upper stomach in 24cases,the gastric body in 25 cases,and the lower stomach in 31 cases.Tumor diameter less than 3cm in 25 cases,tumor diameter greater than or equal to 3cm in 55 cases.64cases were poorly differentiated and 16 cases were moderately differentiated.There were 28 cases in T1+T2 stage and 52 cases in T3+T4 stage.Lymph node metastasis was N0-1 in 5 cases and N2-3 in 75 cases.There were 31 cases in d-dimer normal group and49 cases in d-dimer high group.Platelet count was normal in 75 cases and increased in 5cases.There were 55 cases in normal prealbumin group and 25 cases in low prealbumin group.The platelet distribution width was collected,and receiver operating characteristic curve（ROC）was drawn by SPSS22.0.According to the best cut-off value,PDW was divided into high PDW group and low PDW group.Chi-square test was used to analyze the relationship between PDW and PA groups and clinicopathological features.Kaplan-Meier method was used to draw the survival curve of gastric cancer with PDW and PA,and to compare the overall survival of each group.Univariate and multivariate prognostic analysis were performed by Cox regression model.When P<0.05,it was considered that the difference was statistically significant.Results:According to the preoperative peripheral blood PDW and the survival status of the patients after operation,the ROC curve was constructed,and the area under the curve was 0.741,respectively.According to the best Youden index,the best cut-off values of PDW was 13.45%.PDW was divided into high PDW group（42 cases）and low PDW group（38 cases）.Chi-square test was used to compare clinicopathological features with PDW group and PA group.Results showed that PDW was correlated with age（P<0.05）,PA was correlated with age and tumor diameter（P<0.05）.Kaplan-Meier survival curve showed that the mean overall survival time of the low PDW group was78.894 months,while that of the high PDW group was 53.363 months.The overall survival time of the high PDW group was significantly lower than that of the low PDW group,and the difference was statistically significant（χ~2=19.043,P<0.001）.The mean overall survival time of the low PA group was 53.287 months,and that of the normal PA group was 70.578 months.The overall survival time of gastric cancer patients in the low PA group was significantly lower than that in the normal PA group,and the difference was statistically significant（χ~2=5.124,P=0.02）.Univariate regression analysis by Cox regression model showed that the prognosis of gastric cancer patients was correlated with age,T stage,PA and PDW,and the difference was statistically significant（P<0.05）,Multivariate regression analysis showed that preoperative T stage（P=0.001,HR 3.211,95%CI:1.571-6.564）,PA（P=0.003,HR 0.378,95%CI:0.198-0.722）and PDW（P=0.000,HR 4.457,95%CI:2.167-9.191）were independent risk factors for predicting overall survival of Ⅲ stage gastric cancer.Conclusion:Preoperative peripheral blood platelet distribution width,prealbumin,T stage is an independent risk factor for predicting overall survival after radical gastrectomy.Older patients are more likely to have high platelet distribution width and low prealbumin.The wider the platelet distribution,the lower the prealbumin,the worse the prognosis. |
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